Please click file and print page to print this order form. Mail or fax to
Coconut Villa Gift Shop
157 Chamorro Village; P.O. Box 326133 -  Agana, Guam 96932-6133
Fax: 1-671-472-8580 for International Orders
From USA, TOLL FREE FAX 1-866-623-0294 24 hours.
Please fill out form with "BLACK" ink for best results. THANKS!

SHIP to name_____________________________________________

Address:__________________________________________________

City:________________________State:________Zip:________

CARDHOLDER  Name_____________________________________________

Address:__________________________________________________

City:________________________State:________Zip:________

 Phone:(________)_________-_______________

Your EMAIL Address________________________________________
Stock #
Description
Price Each
Quantity
Total
         
         
         
         
         
         
         
 Coconut Villa Gift Shop Order Form
 Sub-Total $
Click here for Postage Rate Chart
 Postage $
Click here for P & H Rate Chart
 Pack/h andling $
Thank you for your order!
 Grand Total $

Payment Method:
 Circle One
Money Order
MC
Visa
AMEX
 Exp Date MMYY        
Sorry, we do not accept personal or business checks.
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Signature:_______________________________Date ____________



 
 
 
 
 
 
 
 
 
 
 


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157 Chamorro Village; Agana, Guam 96910

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